This revised RO1 application is in response to the Health Disparities in NIDDK Diseases Program Announcement (PA-09-262). It focuses on American Indians (AI) whose rates of type 2 diabetes (T2D) are the highest in the world. This population also copes with disproportionate stressors including economic disadvantage, unemployment, community violence, discrimination, and the long- term effects of historical cultural traumas and losses. Yet, paradoxically, AI people tend to score lower on some self-report measures of stress and have lower prevalence rates of stress-related mental disorders such as major depressive episode and anxiety disorders. The goals of the proposed research are to advance measurement of stress processes among AI people through comparisons of stress biomarkers and self-report measures; and to use multiple indicators of stress including stress biomarkers to investigate the interactions between stress processes T2D disease progression and treatment compliance among AI adults. This community based participatory research is based on partnerships with five Ojibwe reservations in Minnesota and Wisconsin who invited the research team to work with their clinics. The first specific aim is to couple our existing preliminary data on community salient stressors with new qualitative feedback on existing measures to adapt and subsequently examine via pilot surveys the psychometric properties of stress measures for this population. The second specific aim is to investigate the relationship between stress biomarkers and self-reported psychosocial stressors, symptoms of distress, and diagnostic measures of anxiety, depression, and trauma to ascertain the degree to which self report measures are indicative of actual physiological stress levels among a cohort of 200 AI adults who have been recently diagnosed with T2D. The third specific aim is to follow a cohort of 200 recently diagnosed T2D AI adults for two years to investigate an innovative conceptual model (Figure 1) of multiple measures of stress processes, treatment compliance, mental health, and risk factors for disease complications